Please fill out the form below to apply for credit with Dependable Highway Express. We will get back to you as soon as possible. Thank you!  For printable version of this credit application, please click here.  It is in Adobe's Portable Document Format (PDF).  You will need to have Adobe Acrobat on your computer to see and print this form.  Go to Adobe's site and get the free reader.

Company Information
Firm Name
DBA
Address
City
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Zip Code
Note: If moved 1 to 10 years ago, list previous address
Previous Address
Previous City
Previous State	Alabama Alaska Arizona Arkansas California Canal Zone Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Previous Zip Code
Phone #
Fax #
Bill To Address
Tax ID #
Years In Business
Type/ Description of Business
DUNS #
Credit Level Requested: ($)
Sales Representative:
Transportation References
Name
Address
Phone
Fax #
Name
Address
Phone
Fax #
Name
Address
Phone
Fax #
Bank Information
Name
Address
Account #
Phone
By completion and utilization of DHE's Services, you are aware that federal rules and regulations require payment of freight bills within 15 days of presentation as well as the following terms. 1. Our terms are net 30 and discounts may be cancelled on all bills which exceed 45 days. 2. Interest may be charged at the rate of 1.5% per month on any bills which exceeds 30 days. 3. Dhe reserves the right to lien freight pending payment in full. 4. Any collection costs including court fees and attorney fees will be added to the invoice. 5. When account balance exceeds approved credit limits, all subsequent shipments will be driver collect and due at time of pickup or delivery of freight.
APPLICANT'S NAME	TITLE	DATE
APPLICANT AGREES TO ALL TERMS AND CONDITIONS ABOVE
2555 E. Olympic Blvd. Los Angeles, CA 90023 General Office 323-526-2222 Fax: 323-526-2223 Dispatch 323-526-2255   P.O. Box 58047 Los Angeles, CA 90058-0047
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